Welcome to niboonsh’s page.
Contributor score: 336
Comments ...
yng
Yes the superior part supplied by superior thyroid gland which is a branch of external carotid branch.
+
suckitnbme
Superior thyroid artery does supply some blood to the parathyroids through anastomoses but the main vascular supply is from the inferior thyroid artery.
+
jmangels
Also, he's an endurance athlete. It would most likely be a physiological adaptation. "Volume overload-induced cardiac hypertrophy is known as eccentric hypertrophy. In endurance training, the volume load is a predominant factor; therefore, the endurance-trained heart develops eccentric hypertrophy" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2300466/
+2
cbreland
Also, the patient has nothing wrong with him, no symptoms, so the other options are a no go
+
yobo13
Beta 2 agonists relax the uterus so this would be okay, right?
+2
med4fun
inhaled drugs do not have as much of systemic affect and B-agonists are used often in pregnancy for asthma control. SABAS are deemed safe but there are increased birth defects with long acting B-agonists.
+
caitlyncloy
pick C and move on was my strategy :P help lol
+1
waterloo
that's cool and all but there are so many side affects when it comes to TCAs. H1 antagonism, reduced libido, convulsions.
+
drdoom
@niboonsh, ending a comment with a question mark will make it appear on the "comments seeking answers" lists
+4
nwinkelmann
A lymphomatous thyroid gland can either be due to primary thyroid lymphoma (which is almost always NHL, but is very rare) or due to Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. These, I believe, would still present with hypothyroidism, and thus would have low T4 and high TSH (opposite of this patient).
+1
shokay
there is no washout period and the order of drugs given isn't switched
+7
ls3076
Actually was confused about this due to a UW explanation. UW said acute txp rejection has two types - humoral and humoral and cellular. Humoral has Neutrophilic infiltrate + necrotizing vasculitis while cellular has lymphocytosis. Can anyone simplify/explain this please?
+3
apurva
We usually look for c4d complement for humoral response in acute graft rejection. Because c4d makes covalent bond with the endothelium can can be found on staining because it is long lasting.
+
aishu007
hi, but inferior oblique moves up and in and not out
+
athenathefirst
Yeah but how does that help you choose Usual interstital pneumonia?
+
lovebug
Does the drug "SWIM" ? :)
FA19, pg256
+
nor16
and why no therapy, i.e. cognitive training`
+
jessica_kaushal
first step is to make the patient's environment accomodating for the patient.
+2
jessica_kaushal
first step is to make the patient's environment accomodating for the patient.
+
tryntofigritout
Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha
+5
d_holles
Amazing video dude. Somehow never learned this in neuro lol.
+6
aag
Awesome video! Is this why you can give Mg2+ to eclampsia patients, because if so, mind goddamn blown.
+1
Subcomments ...
seagull
i'm pretty sure your a prof and not a student.
+15 2019-06-07T04:53:09Z
nor16
nevertheless, we are greatful for explanation!
+ 2019-07-29T19:03:56Z
niboonsh
I remember seeing a question describe parasternal lift in the context of pulm htn. still got this wrong tho fml
+ 2019-09-13T22:03:43Z
anotherstudent
Did my question have a typo? It says O2 saturation in the right ventricle is 70, which is equal to the Right atrium and vena cava. It says the O2 saturation in the left ventricle is 82%, which is a decrease from the LA (95) but not equal to the RV, which is why I thought there wasn't a VSD, I assumed there was a weird shunt from the LV to some other part. Will O2 saturation not always equalize?
+1 2020-03-21T17:10:47Z
pseudomonalisa
This is a right to left VSD due to the pulmonic stenosis present in Tetralogy of Fallot. O2 sat will be low (70) in the right ventricle, and from there it'll enter the left ventricle and mix with freshly oxygenated blood coming from the left atrium (95). Because of the mixing, the O2 sat of blood in the left ventricle will be somewhere in the middle of 70 and 95 (82 in this case). You're correct, though, that most other VSDs are left to right and you'd see greater O2 sat in the right ventricle in that case (not sure if it equalizes with the left ventricle though).
+ 2020-03-25T01:48:52Z
xxabi
I'm not completely sure...but I think its because its aspirin, and aspirin doesn't work on IIb/IIIa receptors. That's why i picked decreased adherence of platelets, figured that was the closest thing to decreased aggregation that still made sense with aspirin's mechanism of action. Hope that helps!
+2 2019-06-05T18:46:59Z
ihavenolife
Aspirin irreversibly inhibits COX which leads to decreased TXA2. TXA2 normally is a vasoconstrictor and induces platelet aggregation, so aspirin inhibits platelet aggregation by downplaying TXA2 not by interacting with IIb/IIIa receptor. (Source FA and UWorld)
+20 2019-06-09T23:46:25Z
niboonsh
inhibition of IIb/IIIa receptor is the moa of a completely separate class of drugs - Glycoprotein IIb/IIIa (abciximab, eptifabide, tirofiban)
+1 2019-09-13T17:10:51Z
t123
Bad question - TXA2 upregulates GpIIb/IIIa on platelets. So aspirin inhibits their expression.
+1 2020-01-25T17:33:04Z
adisdiadochokinetic
Azithromycin is a macrolide, not an aminoglycoside FYI, and its use in HIV is primarily as prophylaxis at very low CD4 counts for, among other things, the mycobacterium avium complex.
+7 2019-07-20T20:24:59Z
nbmehelp
How would we have known to choose Zidovudine over Lamivudine tho
+5 2019-07-24T21:29:28Z
mjmejora
@nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off
+8 2019-07-28T16:28:14Z
niboonsh
you have ero bone marrow if you take idovudine
+1 2019-09-13T15:16:01Z
niboonsh
the z's were supposed to be bold idk what happened.
you have Zero bone marrow if you take Zidovudine
+5 2019-09-13T15:16:39Z
t123
Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects
+2 2020-01-25T17:36:21Z
adisdiadochokinetic
Azithromycin is a macrolide, not an aminoglycoside FYI, and its use in HIV is primarily as prophylaxis at very low CD4 counts for, among other things, the mycobacterium avium complex.
+7 2019-07-20T20:24:59Z
nbmehelp
How would we have known to choose Zidovudine over Lamivudine tho
+5 2019-07-24T21:29:28Z
mjmejora
@nbmehelp the sketchy with Princess Izolde (Zidovudine) eating bone marrow was my only tip off
+8 2019-07-28T16:28:14Z
niboonsh
you have ero bone marrow if you take idovudine
+1 2019-09-13T15:16:01Z
niboonsh
the z's were supposed to be bold idk what happened.
you have Zero bone marrow if you take Zidovudine
+5 2019-09-13T15:16:39Z
t123
Zidovudine is also a very early NRTI developed. As a good rule of thumb, older drugs have worse side effects
+2 2020-01-25T17:36:21Z
fulminant_life
this question is garbage. She doesnt want to be examined by a male how would the presence of her husband make any difference in that respect?
+12 2019-06-22T19:13:07Z
medpsychosis
The question here focuses on a specific issue which is the patient's religious conservative beliefs vs. urgency of the situation. A physician is required to respect the patient's autonomy while also balancing between beneficence and non-maleficence. The answer choice where the physician asks the patient if it would be ok to perform the exam with the husband present is an attempt to respect the conservative religious belief of the patient (not being exposed or alone with another man in the absence of her husband) while also allowing the physician to provide necessary medical treatment that could be life saving for her and or the child. Again, this allows for the patient to practice autonomy as she has the right to say no.
+15 2019-06-26T01:57:12Z
sahusema
I showed this question to my parents and they said "this is the kind of stuff you study all day?" smh
+25 2019-07-03T15:33:21Z
sherry
I totally agree this is a garbage question. I personally think there is more garbage question on new NBME forms than the previous ones...they can argue in any way. I feel like they were just trying to make people struggle on bad options when everybody knows what they were trying to ask.
+ 2019-07-10T21:39:35Z
niboonsh
This question is a3othobillah
+5 2019-09-12T18:27:10Z
sunshinesweetheart
this question is really not that garbage....actually easy points I was grateful for... yall are just clearly ignorant about Islam. educate yourselves, brethren, just as this exam is trying to get you to do. but yeah I agree there should be an option for female physician lol
+5 2019-10-14T04:18:45Z
drmohandes
I think this NBME24 is a waste of $60.
On one hand we have these types of questions, that have 0 connection to our week-month-year-long studying.
On the other hand we have "Synaptobrevin" instead of SNARE, because f*ck coming up with good questions.
+11 2019-11-22T07:42:25Z
myoclonictonicbionic
@sunshinesweetheart I actually have studied the religion tremendously and there a clear consensus among all Muslims that in the case of an emergency, it is completely allowed to have someone from the opposite gender examine you. I think this actually represents how ignorant the exam writers are of Islam.
+10 2020-01-16T06:45:54Z
korahelqadam
All it takes is one NBME question concerning muslims for the Islamophobia to jump out I guess
+ 2020-04-13T04:59:45Z
sars
This is a very fair question. I agree with sunshinesweetheart above. That is all.
+ 2020-05-11T23:11:41Z
alimd
well we should wait for the question "if a man shouts I CANT BREATHE with a police knee on his neck, what is your next step? Ans- wait 8 minutes."
+1 2020-06-01T20:57:30Z
sympathetikey
Yep. I didn't even look at the X-ray.
+9 2019-06-09T06:43:07Z
dr.xx
loonies love lunate
+2 2019-06-23T18:11:50Z
wes79
she landed on her "right hand", but the X-ray is showing a left hand??
+1 2019-06-28T01:08:28Z
wes79
i legit have no idea whats going on in that xray lol
+9 2019-06-28T01:08:42Z
nbme4unme
X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha.
+1 2019-07-06T00:58:13Z
nwinkelmann
for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality.
+3 2019-07-13T01:02:56Z
niboonsh
Some Lovers Try Positions That They Cant Handle
+9 2019-09-12T17:53:29Z
vsn001
ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D
+ 2020-05-05T21:04:18Z
regularstudent
Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic
+ 2020-05-07T23:28:51Z
sars
I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome.
+ 2020-05-12T23:16:30Z
youssefa
Cause we all know what bout to happen to us in this exam :D
+33 2019-07-24T14:19:09Z
happysingh
i've never heard of " 6. Small Blue Cells" cancer / tumor / carcinoma ....
+1 2019-09-10T19:04:16Z
niboonsh
might want to look at fa pg 665
+ 2019-09-10T20:34:55Z
niboonsh
because extravascular hemolysis is associated w jaundice. Intravascular hemolysis would have hemoglobinuria but that's not an answer
+1 2019-09-10T03:15:07Z
niboonsh
i mean that is the answer lol
+ 2019-09-10T03:15:55Z
krewfoo99
According to pathoma: Intrvascular haemolysis will lead to haemoglobin binding to haptoglobin. This complex will travel to the kidneys and be excreted. This will lead to red colored urine and haemosiduria (Note: This can also lead to acute tubular necrosis)
Extravascular haemolysis is when macrophages break down the RBC. Then the Haeme is converted to biliverdin then bilirubin and conjugated in liver, and then excreted.
+4 2019-11-02T21:38:01Z
paperbackwriter
If you look under the "clinical presentation" column of the blood transfusion reactions chart (pg114), it says that hemoglobinuria is with intravascular hemolysis and jaundice is with extravascular. Makes sense because with extravascular hemolysis your splenic macrophages are are chewing up the RBCs and sequestering it in the spleen so you don't get "spillover" -- i.e. clean urine.
+1 2020-02-29T22:29:11Z
niboonsh
because extravascular hemolysis is associated w jaundice. Intravascular hemolysis would have hemoglobinuria but that's not an answer
+1 2019-09-10T03:15:07Z
niboonsh
i mean that is the answer lol
+ 2019-09-10T03:15:55Z
krewfoo99
According to pathoma: Intrvascular haemolysis will lead to haemoglobin binding to haptoglobin. This complex will travel to the kidneys and be excreted. This will lead to red colored urine and haemosiduria (Note: This can also lead to acute tubular necrosis)
Extravascular haemolysis is when macrophages break down the RBC. Then the Haeme is converted to biliverdin then bilirubin and conjugated in liver, and then excreted.
+4 2019-11-02T21:38:01Z
paperbackwriter
If you look under the "clinical presentation" column of the blood transfusion reactions chart (pg114), it says that hemoglobinuria is with intravascular hemolysis and jaundice is with extravascular. Makes sense because with extravascular hemolysis your splenic macrophages are are chewing up the RBCs and sequestering it in the spleen so you don't get "spillover" -- i.e. clean urine.
+1 2020-02-29T22:29:11Z
jcrll
"live-born offspring" ← baited
+21 2019-06-04T01:56:49Z
niboonsh
why is it 50% females tho?
+2 2019-06-27T20:50:49Z
imgdoc
felt like an idiot after i figured out why i got this wrong.
+1 2019-07-02T18:09:44Z
temmy
oh shit!
+ 2019-07-11T22:23:08Z
suckitnbme
This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected.
+2 2020-01-14T17:33:49Z
makinallkindzofgainz
@suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0.
+3 2020-01-18T19:03:05Z
spow
@suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant
+2 2020-02-09T00:24:04Z
qball
Jail-baited
+ 2020-02-11T19:31:38Z
niboonsh
This question makes me want to vomit
+11 2019-06-27T19:31:17Z
drdoom
The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend.
+1 2019-06-13T18:21:02Z
niboonsh
aka 'merica #firstworldproblems
+4 2019-06-26T22:10:29Z
makinallkindzofgainz
If you are obese, it's because you have consumed calories in excess of your energy expenditure, end of story. (there are factors that affect your energy expenditure, but the simple statement is 100% true, unless you want to argue against the laws of thermodynamics). A is the only correct answer.
+1 2020-01-25T18:34:33Z
tulsigabbard
This answer hit too close to home.
+4 2020-01-29T21:03:34Z
castlblack
I think the reason they point out the average weight of the parents is because leptin disorders are inherited. It helps you eliminate that answer choice.
+1 2020-03-01T23:00:49Z
goldenwakosu
I think it’s because meningiomas are able to calcify (aka sometimes they have psamomma bodies). I got this question wrong too but I totally did not completely register that the tumor was in the dura (interhemispheric fissure + central sulcus). Hope that helps!
+2 2019-06-01T22:37:51Z
pipter
the only reason I got this right was because they described the tumour as being near the falx cerebri.
+2 2019-06-01T22:38:44Z
fcambridge
Other hints include being described as round and seen in a female. Both indicative of Meningioma
+15 2019-06-07T20:17:49Z
niboonsh
also meningiomas typically present with seizures or focal neurological signs
+ 2019-06-26T18:24:32Z
suckitnbme
I thought enhancing meant it uptakes contrast. Meningiomas are commonly enhancing lesions per Radiopaedia.
+ 2020-01-11T20:16:56Z
ht3
you're definitely not alone lol
+ 2019-06-08T22:42:31Z
yotsubato
And its not in FA, so fuck it IMO
+1 2019-06-14T10:54:51Z
epr94
did not
+ 2019-07-02T15:12:12Z
link981
I guessed it because the names sounded similar :D
+14 2019-07-03T01:30:33Z
yb_26
I also guessed because both words start with "glu")))
+27 2019-07-10T03:20:52Z
impostersyndromel1000
same as person above me. also bc arginine carbamoyl phosphate and nag are all related through urea cycle.
+1 2019-07-12T16:20:01Z
jaxx
Not a clue. This was so random.
+ 2019-07-17T13:09:58Z
ls3076
no way
+ 2019-08-07T04:43:36Z
mkreamy
this made me feel a lot better.
also, no fucking clue
+1 2019-09-29T07:44:14Z
amirmullick3
My immediate thought after reading this was "why would i know this and how does this make me a better doctor?"
+7 2019-11-16T22:30:44Z
mrglass
Generally speaking Glutamine is often used to aminate things. Think brain nitrogen metabolism. You know that F-6-P isn't an amine, and that Glucosamine is, so Glutamine isn't an unrealistic guess.
+4 2020-01-08T23:24:25Z
djtallahassee
yea, I mature 30k anki cards to see this bs
+4 2020-01-12T03:23:19Z
taediggity
I literally shouted wtf in quiet library at this question.
+1 2020-01-19T06:27:59Z
bend_nbme_over
Lol def didn't know it. Looks like I'm not going to be a competent doctor because I don't know the hexosamine pathway lol
+21 2020-02-02T14:16:22Z
drschmoctor
Is it biochemistry? Then I do not know it.
+4 2020-02-03T21:04:39Z
roro17
I didn’t
+ 2020-02-07T22:48:14Z
jesusisking
I Ctrl+F'd glucosamine in FA and it's not even there lol
+ 2020-02-17T02:38:07Z
batmane
i definitely guessed, for some reason got it down to arginine and glutamine
+1 2020-02-18T02:51:15Z
monique
I did not
+ 2020-03-04T22:22:31Z
baja_blast
Narrowed it down to Arginine and Glutamine figuring the Nitrogen would have to come from one of these two but of course I picked the wrong one. Classic.
+1 2020-03-17T16:13:55Z
amy
+1 no idea!
+ 2020-03-23T02:49:50Z
feeeeeever
Ahhh yes the classic Glucosamine from fructose 6-phosphate question....Missed this question harder than the Misoprostol missed swing
+1 2020-05-21T22:50:07Z
schep
no idea. i could only safely eliminate carbamoyl phosphate because that's urea cycle
+ 2020-06-08T13:53:19Z
kidokick
just adding in to say, nope.
+ 2020-07-06T07:03:43Z
flvent2120
Lol I didn't either. I think this is just critical thinking though. The amine has to come from somewhere. Glutamine/glutamate is known to transfer amines at the least
+1 2020-07-09T02:50:54Z
meningitis
This is common in Klinefelter.. think of the equivalent of Streaked ovaries seen in Turners. White streaks, red/pink material of hyaline, and hyperplasia of Leydig cells. Just remember: It doesn't look like normal structured testicle histology (No organized seminiferous tubules with Sertoli cells around)
+10 2019-06-12T04:20:57Z
.ooo.
I believe they were asking what the most common effect of statins, which is GI upset (including diarrhea). Rarely you can have hepatotoxicity and myopathy but neither of these are a side effect in the answer choices. Hopefully this helps!
+1 2019-06-10T17:17:10Z
niboonsh
Theyre asking about the most common side effect of Orlistat - which is really fatty diarrhea
+3 2019-06-26T01:47:21Z
asharm10
Orlistat is not a statin drug, it basically inhibits pancreatic lipase so that you absorb less fatm drug is used for weight loss. So when you are not absorbing fat you are inviting diarrhea.
+2 2020-02-17T10:23:59Z
niboonsh
Autosomal Dominant disorders usually present as defects in structural genes, where as Autosomal Recessive disorders usually present as enzyme deficiencies. P450 is an enzyme, so we are probably dealing with an autosomal recessive disorder. furthermore, the question states there was a "homozygous presence of p450.....". In autosomal recessive problemos, parents are usually heterozygous, meaning that 1/4 of their kiddos will be affected (aka homozygous), 1/2 of the kids will be carriers, and 1/4 of their kids will be unaffected.
+36 2019-06-26T00:10:10Z
nwinkelmann
Is this how we should attack this probelm?: First clue stating endoxifen is active metabolite of Tamoxifen should make us recognize this undering first pass hepatic CYP450 metabolism? Once we know that, the fact that the metabolite is decrease suggests an enzyme defect, which is supported by patient's homozygous enzyme alleles. Then use the general rule that enzyme defects are AR whereas structural protein defects are AD inheritance patters. Once we know the pattern, think that most common transmission of AR comes from two carrier parents. So offspring alleles = 25% homozygous normal, 50% heterozygous carrier, and 25% homozygous affected, thus sister has a 25% of having the same alleles as patient (i.e. homozygous CYP450 2D6*4)?
+6 2019-07-06T17:26:48Z
impostersyndromel1000
we had the exact same thought process, so i too am hoping this is the correct way to approach it
get reasoning friend
+ 2019-07-12T16:33:40Z
ajss
thanks for this explanation, I totally forgot about AR patterns are most likely enzymes deficiencies, this kind of make the question easier if you approach it that way, thanks
+ 2020-01-01T20:51:40Z
niboonsh
the question is asking what would happen to the URINARY ph, bicarb, and volume. dont worry, i misread the question too -_-
+12 2019-06-25T23:16:25Z
link981
Also misread the question, thought about the lab volumes of the BLOOD smh
+5 2019-07-03T01:01:39Z
hyperfukus
yooooo me too!!! this is the second NBME i did this on they purposely don't write urine on the arrow categories to mess u up i swear!!! AHHHHHH
+2 2019-08-11T16:04:10Z
medulla
missed this question for the same reason .. still pissed
+2 2019-08-16T16:45:35Z
keycompany
This is a great rationale. I would like to add on that D is wrong because Radicular Neuropathy of the anterior lumbar roots would (1) be painful [radicular neuropathy is characterized by radiating pain (hence the word “Radicular”); this patient has numbness and tingling, not pain] and (2) because the anterior lumbar roots are the motor roots and do not carry sensory innervation. This patient is having a problem with his dorsal spinal cord (not anterior/ventral).
+30 2019-06-02T02:21:57Z
hello
Want to clarify that "radiculopathy" is not synonymous with pain. Radiculopathy can cause pain, weakness, or numbness.
I think the only reason Choice D. was incorrect because it discussed the "anterior lumbar roots", which would affect motor function.
+15 2019-06-11T18:23:45Z
niboonsh
Radiculopathy is damage to the actual nerve itself, wouldnt that make it a LMN lesion and babinski would be negative?
+1 2019-06-25T23:13:21Z
link981
Great explanation guys
+ 2019-07-02T20:54:31Z
usmel2020
UW QID: 12035 explains what you are testing with Romberg sign
+5 2020-02-07T23:37:16Z
jurrutia
"Radiculo-pathy" comes from latin terms meaning "root-disease".
+ 2020-07-11T13:33:18Z
yotsubato
How is that NOT posterior to middle concha? bad question
+10 2019-06-12T11:09:24Z
sympathetikey
@yotsubato - That would have been if it was the spehnoid sinus (I got it wrong too btw)
+2 2019-06-12T23:13:12Z
sahusema
Sphenoethmoidal RECESS not sphenoethmoidal SINUS
+3 2019-07-19T16:47:09Z
niboonsh
yea it was a dumbass question, whoever is writing these questions is undoubtedly a crazy genius but homeboy (or homegirl...homeperson?) needs a few grammar lessons.
+4 2019-06-24T02:13:01Z
yex
I agree. We know that it is a teratogen, but how does that question directs you to think about teratogenic effects instead of something physiologic?
+5 2019-07-03T21:50:22Z
dr_jan_itor
The questions in the NBMEs by default are reject questions. So highly selective to be awful questsions. I am recieving regular heads up that the stems on the real thing lately are like 10-12 lines long. So these questions are not anywhere near like the test. NBME has f'd us good for this particular round of practice forms.
+ 2019-07-30T13:29:39Z
meningitis
More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico).
Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities.
+12 2019-06-04T21:44:35Z
nala_ula
I'm shocked that I found a fellow puerto rican on this site! Good luck on your test!
+1 2019-06-17T00:55:13Z
namira
dont be shocked! me too! exito!
+2 2019-06-22T23:08:12Z
dr_jan_itor
I was thinking that its Murine typhus transmitted by fleas
+ 2019-08-02T18:27:35Z
monique
I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection.
+2 2019-11-18T05:44:30Z
jakeperalta
Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience.
+ 2019-11-29T15:27:44Z
almondbreeze
UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika
+ 2020-01-10T08:27:47Z
lovebug
FA2019, page 167 RNA virusesy.
+ 2020-05-24T06:47:48Z
lovebug
Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on the face, trunk and limbs. It is typically asymptomatic but may be pruritic (Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. )
+1 2020-05-24T06:53:20Z
niboonsh
Im mad at how simple this question actually is
+7 2019-06-23T20:02:43Z
sahusema
Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence
+3 2019-07-18T18:25:08Z
meningitis
The above explanation is correct (disregarding the hard to read and unprofessional dialect) but just in case anyone was wondering:
chromatin-negative= Just a quick way of knowing it was a boy. The term applies to the nuclei of cells in normal males as well as those in individuals with certain chromosomal abnormalities
+16 2019-06-04T01:41:27Z
yotsubato
Turner syndrome patients are also chromatin negative as well though....
+5 2019-06-12T09:42:22Z
sympathetikey
I didn't know a complication post-meningitis was lack of humor.
+5 2019-06-13T02:09:35Z
sympathetikey
Ah, didn't read the last line. Yeah, that is taking it a bit far
+20 2019-06-13T02:10:51Z
niboonsh
yall are haters. this is the first explanation that has ever made sense to me
+5 2019-06-23T02:19:23Z
whoissaad
How does chormatin-negative indicate a normal cell? Isn't chormatin just condensed DNA?
+1 2019-07-15T20:21:17Z
cienfuegos
According to this paper most individuals with Turner Syndrome are chromatin negative: "One of the initial laboratory procedures used to confirm or rule out this diagnosis involves a sex chromatin determination from a buccal smear. Cells from the lining of the mouth are stained for the presence or absence of X-chromatin or Barr bodies, which represent a portion of an inactivated X chromosome. The typical Turner’s syndrome patient, who has 45 chromosomes and only one sex chromosome (an X), has no Barr bodies and is, therefore, X-chromatin negative.
This abnormal X-chromatin negative finding in the majority of Turner’s syndrome females is similar to the result found in a normal male, who also has only one X chromosome, and differs from the X-chromatin positive condition observed in the normal female, who has two X chromosomes. Occasionally, the patient with features of Turner’s syndrome is found to be X-chromatin positive."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233891/
+1 2019-07-23T16:28:33Z
hyperfukus
i really hate haters this is awesome!
+1 2019-08-07T07:01:09Z
selectuw
to add to the above, free testosterone is aromatized to estrogen leading to breast development
+ 2019-12-22T22:54:35Z
misrao
Is the free testosterone not creating male internal or external gentalia because of the defect in androgen receptors?
+ 2020-06-26T20:02:31Z
mrsmac
No sertoli cells or lack of mullerian inhibitory factor makes more sense. bc there is both male and female internal genitalia but only male external genatalia. and karyotype would show 46XY. First Aid 2018 pg. 604 - the "Sexual Differentiation" charge delineates exactly this. If it were 5areductase deficiency the child would have testicles and scrotum, which in this case is absence. Hope this makes sense. Please let me know if you disagree and why. Thanks.
+ 2019-06-13T16:56:30Z
mixmasta
I believe the tricky part is that they don't mention the status of the Male external genitalia. Pg. 605 from FA ( bottom portion) shows the external development of the Male/Female genitalia; you see DHT is need for male. Furthermore, pg. 604 (SEXUAL DIFFERENTIATION) DHT is also needed for Male external development.
+ 2019-06-14T16:47:56Z
niboonsh
My understanding of this is that the diagnosis is 5alpha reductase deficiency because the newborn has female external (aka ambiguous) with male internal (aka "male genital ducts"). According to FA, leydig cells produce testosterone, which can either stimulate the mesonephric duct to form the INTERNAL male genitals (as see in the pt). Testosterone can also be acted on by 5alpha reductase to become Dihydrotestosterone, which forms the male EXTERNAL genitalia. Since this kid has "female" genitals, but has male insides and is 46XY, id say this is a simple case of 5alpha reductase deficiency.
No sertoli cells or no MIF would present as both female and male internal (because MIF typically inhibits differentiation of female internal) and male external genitalia (bcuz leydig cells are unaffected)
+15 2019-06-22T20:00:48Z
niboonsh
yea, aeresol transmission via bat poop in caves
+ 2019-06-22T16:56:00Z
len49
How do you know the virus was inhaled? Doesn't mention it. Moreover, non-bite/scratch transmission is extremely rare.
+ 2020-01-17T17:48:37Z
drzed
She was probably bitten by a bat; many times the bite is not recognized ('unapparent bites'), and thus the CDC recommends that even if you think you have been bitten by a bat (or that you COULD have been bitten), you should go and get active/passive immunization immediately.
+ 2020-02-01T19:16:52Z
mangotango
Sketchy (and Zanki) says you can get rabies via animal bites OR aerosol transmission. In the U.S. it's most commonly through bats. It could also be through skunks (Western U.S.) or foxes/raccoons (Eastern U.S.).
I remember this by thinking about how skunks smell so bad!
+ 2020-04-28T04:19:23Z
scalpelofthenorth
Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me.
+ 2019-05-25T04:10:31Z
neonem
But tyrosine can come from phenylalanine, so it's not really essential right?
+ 2019-05-29T03:31:45Z
gh889
in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected.
+15 2019-06-03T17:04:13Z
usmleuser007
Note: Tyrosine is ONLY essential with PKU in children
+ 2019-06-10T16:38:18Z
niboonsh
bro FA2018 lists tyrosine as an essential AA. They played us.
+1 2019-06-22T16:13:04Z
meningitis
Thank you for your explanation!
One question: How about the serine phosphorylation? Is it answered by pure memorization that the FOXO TF is serine phosphorylated, or is it a general fact that all TF's are serine-threonine phosphorylated?
+ 2019-06-04T00:20:05Z
tsl19
I'm not sure, but it may be as simple as this: ubiquitin-mediated proteolysis is irreversible, but both N/C shuttling and phosphorylation are generally reversible processes.
+ 2019-06-09T18:07:53Z
didelphus
I also guessed that FOXO must be a part of the PI3K pathway, since insulin regulates metabolism through PI3K and the question stem specifically mentions that. Phosphorylation is a major part of that pathway, so even indirectly phosphorylation would regulate FOXO. Frustrating question.
+17 2019-06-10T01:44:37Z
alexb
According to wikipedia (https://en.wikipedia.org/wiki/FOXO1) phosphorylation of FOXO1 is irreversible. This is referring to phosphorylation of serine residues on FOXO by Akt, which occurs in response to insulin. But the NBME answer suggests it's reversible. What's up?
+1 2019-07-01T20:04:18Z
almondbreeze
could wiki be wrong on phosphorylation being irreversible? according to this article, it is a reversible process: regulation of FoxO transcription factors by reversible phosphorylation and acetylation (https://www.sciencedirect.com/science/article/pii/S0167488911000735#s0010)
some wiki info, however, is helpful : In its un-phosphorylated state, FOXO1 is localized to the nucleus, where it binds to the insulin response sequence located in the promoter for glucose 6-phosphatase and increases its rate of transcription. FOXO1, through increasing transcription of glucose-6-phosphatase, indirectly increases the rate of hepatic glucose production.[19] However, when FOXO1 is phosphorylated by Akt on Thr-24, Ser-256, and Ser-319, it is excluded from the nucleus, where it is then ubiquitinated and degraded. The phosphorylation of FOXO1 by Akt subsequently decreases the hepatic glucose production through a decrease in transcription of glucose 6-phosphatase.
+ 2020-01-11T06:48:45Z
leaf_house
It seems like the phosphorylation from Akt leads to destruction, but maybe the assumption is that that phosphorylation step (excluding every other step of ubiquitin-proteosome pathway) is reversible, where proteolysis is final.
@niboonsh video is good but doesn't split this one.
+ 2020-03-25T05:36:50Z
niboonsh
rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018
+11 2019-06-21T23:48:12Z
dr_jan_itor
what if the alcoholic just has a concurrent rhinovirus infection ;)
+5 2019-08-02T17:02:01Z
lovebug
and FA2019 page 538.
+ 2020-05-29T12:49:22Z
sweetmed
or metronidazole
+ 2019-06-20T02:47:20Z
niboonsh
what would his diagnosis be tho?
+ 2019-06-21T22:44:19Z
lostweightthxnorovirus
@niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good!
+1 2019-06-22T10:07:22Z
nwinkelmann
Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA).
+8 2019-07-05T19:02:27Z
mannywillsee
This little bug has has a face, and now you can't unsee it either!
+ 2020-02-27T02:50:54Z
yotsubato
This is not in FA btw.
+9 2019-06-12T07:13:41Z
eacv
I though in this one as a sick sinus syndrome hahaha in UW.
+ 2019-08-16T19:00:16Z
pg32
Pretty sure boards and beyond teaches this wrong. Dr. Ryan says that in euthyroid sick syndrome T3, T4 and TSH will be low, but rT3 will be elevated.
+ 2020-01-19T20:49:15Z
pathogen7
In reality, TSH and T4 levels can be highly variable based on the stage of Euthyroid sick syndrome. One thing that happens for sure, I believe, is that T3 is down and rT3 is up.
+1 2020-02-06T22:25:10Z
gh889
I think you meant 2(29/30)(1/30) just to clarify!
+7 2019-06-03T22:26:20Z
arkmoses
You have to use the hardy weinberg formula (1=p^2+2qp+q^2)and p + q = 1 they basically tell you that q^2=1/900 which makes q=1/30 now you can figure out (p=1-q) so p=1-(1/30), p=29/30 then to figure out carrier you solve for 2qp, 2(29/30)(1/30)=1/15 I got it wrong cuz I forgot how to figure out p but hopefully wont happen on the real deal.
+5 2019-06-23T05:38:07Z
garibay92
2pq= 2(29/30)(1/30).... Transform this to 2 1 1 2 1
x x = _ = ____
1 1 30 30 15
+ 2019-07-29T23:47:13Z
garibay92
Nevermind :/ It didn't come out as planned :(
+ 2019-07-29T23:51:13Z
garibay92
/Users/carlosgutierrez/Desktop/IMG_2423.jpg
+ 2019-07-30T01:24:52Z
pg32
How do we know this disease is autosomal recessive? I assumed it was just because they love these carrier frequency questions with AR diseases, but how do we know it's AR?
+ 2020-01-19T20:07:30Z
turtlepenlight
Sounds like Gaucher (ish?) if i'm remembering correctly
+5 2020-01-22T02:22:38Z
yotsubato
This patient does not undergo a water deprivation test
+12 2019-06-10T11:08:20Z
niboonsh
Compulsive water drinking or psychogenic polydipsia is now increasingly seen in psychiatric populations. Effects of increased water intake can lead to hyponatremia causing symptoms of nausea, vomiting, seizures, delirium and can even be life threatening if not recognized and managed early.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579464/
+7 2019-06-16T15:51:03Z
missi19998
Just wondering why it in not resistance to ADH action of vasopressin
+ 2019-06-23T19:42:28Z
amarousis
because he would be hypernatremic with no ADH. can't resorb any water
+1 2019-06-30T22:10:04Z
minhphuongpnt07
low osm/urine, low os/plasma => psychogenic polydipsia
+ 2019-08-15T22:56:29Z
benitezmena
In this question the pt had a normal urine osm (80) a low urine osm would be <50mosmol/kg.
+ 2019-11-29T21:12:26Z
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